HomeMy WebLinkAbout104 Long Pond Road paper application/i x\A,,rl a PJo @-tuu D
Application for 2024 Rental Registration
TOWN OF YARMOUTH
Health Department
1.I46 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664
Telephone (508) 398-2231 , ext. 1240
Fax (508) 760-3472
E-mail: epo lite@ya rmo uth. ma. usw
'IT fne Town of Yarmouth is excited to announce that we've streamlined the online registratron process to
make it more user-friendly than ever beforel Simply visit https://varmouthma. portal.openqov.com/ to get
started. There, you can effortlessly create your account and conveniently pay the registration fee.
Using this upgraded system, you'll have the power to engage with us throughout the entire process. Not only
can you securely communicate with our team, but you'll also gain access to 'iour important documents, the
ability to upload photos, and much more! This improved platform is designed to make your registration
lxperience smooth and efficient.
Smoke Detectors and Carbon Monoxide Detectors are Required!
Owners: I have ensured the batteries are changed, have tested ALL Smoke Detectors/Carbon
Monoxide Detectors and verified that they are less than 10 years old: P/ease initiala-
Contact the Building Department regarding questions on type and location prior to purchasing,
httos //www varmouth ma r.rs/DocumentCenterNleWl 1 221lSrr oke-deleclor'location
A non-refundabteapptication fee of $80 per uniUrental is required.
Rental Certificates expire on December 31"r, 2024.
lf NOT registering online, please make checks payable to: Town of Yannout'r and rnail mnpleted application &
paymenl to: Town of Yarmouth Health Department.
The Health Depaftment will callto schedule an inspection if required, upon receipt of your application and fee.
Rental Property Address
t0,l /cnePOJ Rental Period:
Seasonal Short Term less than 31 da S
Trash Removal by:
Owner Tenan,t/US artment RoomDUlex Condo
Rental of:
Prgperty Owner Name.
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Mailing Address:
6o Fo6ST RD S l,1k
Alternate Phone No
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(required)E-mail Address
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Noil9-
ne SAgenUAgency Prjmary Phone No (required)E-mail Address
5,Y#j!:lffiflt.Tf,"rstand I must notifv the Health Department in writing when I am no tonger renting the property, or I may be
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Sign /1 Date: //-J2 -A-3
Rental Property lnformation
AII fields are re utred! lncom lete forms without a valid phone # or email cannot be rocessed
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Revised: 10/23/2023
Annualj
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( requrred)Primarv Phone No.A}JLq c?l f-56-8A* 0qG t